The Center for Sports Medicine and Physical Therapy

Primary specialty

Sports Medicine (Neuromusculoskeletal Medicine) PhysicianTaxonomy code 204C00000X

License

25MA07567400 Issued in NJ

Legal business name

THE CENTER FOR SPORTS MEDICINE AND PHYSICAL THERAPY

Practice address

1011 Main Ave
Clifton, NJ 07011-2333

Phone

(973) 777-0934

NPI assigned

Aug 23, 2006

Last updated

Jul 21, 2022By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Joann Derosa

Title

Account Manager

Phone

(201) 986-1003

Specialties & licenses 1

Addresses

Tax ID family

Center for Sports Medicine Physical Therapy2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Center for Sports Medicine & Physical Therapy

  • Acupuncturist
  • Clifton, NJ
  • NPI 1861521536
  NPD tax ID

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156291200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1265548978",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1011 MAIN AVE",
            "city": "CLIFTON",
            "state": "NJ",
            "postal_code": "070112333",
            "telephone_number": "973-777-0934"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1011 MAIN AVE",
            "city": "CLIFTON",
            "state": "NJ",
            "postal_code": "070112333",
            "telephone_number": "973-777-0934"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE CENTER FOR SPORTS MEDICINE AND PHYSICAL THERAPY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-23",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "DEROSA",
        "authorized_official_first_name": "JOANN",
        "authorized_official_title_or_position": "ACCOUNT MANAGER",
        "authorized_official_telephone_number": "201-986-1003"
    },
    "taxonomies": [
        {
            "code": "204C00000X",
            "taxonomy_group": "",
            "desc": "Neuromusculoskeletal Medicine, Sports Medicine",
            "state": "NJ",
            "license": "25MA07567400",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Sports Medicine (Neuromusculoskeletal Medicine) Physician in Clifton, NJ
• Providers in Clifton, NJ by specialty
• Sports Medicine (Neuromusculoskeletal Medicine) Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.